Treatment Retention Strategies in Transition Age Youth

描述(由申请人提供)：本申请涉及广泛的挑战领域(04)临床研究和具体挑战主题，04-MH-105：进行试点研究，以开发和测试适合发展的循证预防干预和服务提供模式，适用于患有严重精神疾病高危人群或正在过渡到成年的青少年。随着他们进入成年期过渡年龄，患有严重精神健康问题的青年(Tay；17-25岁)功能严重不良；无家可归(30%)、逮捕(60%)、辍学(42%)和失业(见1)的比率很高。这些问题可以通过良好的心理健康(MH)治疗来减少。然而，在寻求MH护理的成年人中，Tay始终是最有可能退出治疗的(例如2)，他们在年长或年轻的人中完成的疗程最少。3没有治疗保留(TR)就没有MH治疗。改善Tay功能的一个简单且可能具有成本效益的步骤是为最常用的MH治疗制定有效的tr干预措施；以办公室为基础的门诊心理治疗。4目前还没有正在进行的临床试验或公布的tr干预措施。这项拟议的研究为Tay量身定做的办公室门诊心理治疗开发和试点了一种新的tr干预措施，并试点测试了一种尚未在该年龄段检查的现有干预措施。虽然Tay患者放弃治疗的具体原因尚未被调查，但可能是多方面的。在成年人中，已经确定了多种导致治疗中断的原因，研究中没有发现主导因素。成熟成人和Tay可能有一些共同的早产原因，但由于过渡期独特的发育和生命阶段特征(见6)，成人成功的TR干预不太可能与Tay一样有效。一些独特的发展特征可能导致Tay中的tr受损，包括：“年龄典型的对权威的拒绝，可能会干扰治疗关系，以及不成熟的认知发展，可能会干扰治疗目标设定的抽象任务”，不成熟的责任承担，可能会干扰参加会议和接受治疗的工作，特别是因为父母的影响在过渡到成年期间减少“由于在这些年龄段接受同伴接受和追求浪漫关系的中心，人们强烈地感受到需要心理健康治疗的耻辱，这可能会减少tr。这项拟议的研究将开始对动机访谈(MI)7进行测试，以此作为Tay中的一种tr干预。MI是一种广泛使用的干预措施，用于增强动机和减少对变化的矛盾心理，这提高了年长和年轻年龄组的治疗依从性。MI还很有吸引力，因为它可以很容易地添加到标准治疗中。此外，将开发针对Tay独有的、与MI靶向不同的TR机制的第二种TR干预措施。拟议的研究采取了初步步骤，以确定这两种方法在增加Tay-Tr方面的有效性。这项研究将启动针对发展量身定做的TR干预措施的开发和可行性评估，并启动研究设计的可行性，以试点测试这两种TR干预措施，并将其与“照常服务”进行比较。这是确定是否能找到足够的证据来证明全面临床试验的合理性的初步步骤。这两项Trr干预措施是：“同伴治疗教练(PTC)；这项以支持参与门诊心理治疗为重点的基于网络的同行干预将在拟议的研究中开发”动机访谈(MI)；这项由治疗师实施的干预措施已用于提高成人和青少年在成瘾、健康和MH治疗方面的治疗依从性，但尚未作为过渡年龄青年的一项tr策略进行专门测试。目的1.明确一种新的门诊MH心理治疗的实施和培训方案以及保真度测量(PTC)。目的2.确定PTC方法和随机临床试验研究设计的可行性，将激励访谈和PTC与常规服务进行比较。这项研究将通过同时开发一种量身定制的tr干预措施，并测试一个在这个年龄段没有尝试过的成功的tr干预措施，从而启动在广泛使用的治疗中留住更多过渡年龄青年的进展。它将与总统的恢复和再投资法案保持一致，将97%的直接成本预算用于人员，并为患有精神残疾的青年提供就业机会。在过渡到成年期间有心理健康需求的年轻人在工作、独立生活和远离法律麻烦方面的功能受到了极大的损害。每年有760,000名过渡年龄青年(17-25岁)获得以办公室为基础的心理健康治疗，但这一广泛提供的治疗的影响在这一年龄组中受到影响，因为他们特别容易退出治疗。如果在拟议研究中试行的两种有希望的治疗辍学预防干预措施取得成功，未来将有更多的过渡年龄青年继续接受治疗，以使其对症状产生有益影响，进而对功能产生有益影响。

DESCRIPTION (provided by applicant): This application addresses broad Challenge Area (04) Clinical Research and specific Challenge Topic, 04- MH-105: Conduct pilot studies to develop and test developmentally appropriate, evidence-based prevention interventions and service delivery models for youth with who are at high risk for, or experiencing severe mental illnesses who are transitioning to adulthood. As they move into adulthood transition age youth (TAY; ages 17-25) with serious mental health conditions have alarmingly poor functioning; high rates of homelessness (30%), arrests (60%), school dropout (42%), and unemployment (see1). These problems could be reduced by good mental health (MH) treatment. However, among adults who seek MH care, TAY are consistently the most likely to drop out of treatment (e.g.2), and they complete the fewest number of sessions among those older or younger.3 There is no MH treatment without treatment retention (TR). A simple and potentially cost-effective step to improving TAY functioning is to develop effective TR interventions for the most commonly used MH treatment; office-based outpatient psychotherapy.4 There are currently no clinical trials underway or published TR interventions for TAY. The proposed study develops and pilots a new TR intervention for office-based outpatient psychotherapy tailored for TAY, and pilot tests an existing intervention not yet examined in this age group. Though the specific causes of treatment dropout in TAY have not been investigated, they are likely manifold. Multiple causes of treatment dropout have been identified in adults5 with no predominant factor emerging from the research. Mature adults and TAY likely share some causes of premature termination, but because of the unique developmental and life stage features of the transition period (see6) it is unlikely that successful TR interventions in adults are as effective with TAY. Some of the unique developmental characteristics that can contribute to compromised TR in TAY include: " Age-typical rejection of authority that can interfere with therapeutic relationships, and immature cognitive development that can interfere with the abstract task of therapeutic goal-setting " Immature responsibility-taking that may interfere with attending sessions and embracing the work of therapy, especially since parental influence diminishes during the transition to adulthood " The stigma of needing mental health treatment is keenly felt because of the centrality of peer acceptance and pursuit of romantic relationships at these ages, and may reduce TR. The proposed research will begin the work of testing Motivational Interviewing (MI)7 as a TR intervention in TAY. MI is a widely used intervention to enhance motivation and reduce ambivalence about change, that has increased treatment adherence in older and younger age groups. MI is additionally appealing because it can readily be added to standard therapy. In addition, a second TR intervention will be developed that targets mechanisms of TR that are likely unique to TAY and are different than those targeted in MI. The proposed research undertakes the initial steps towards determining the efficacy of these two approaches in increasing TAY TR. The research will initiate development and feasibility assessment of the developmentally tailored TR intervention, and feasibility of the research design to pilot test both TR interventions in comparison to "services as usual." It is the preliminary step to determine whether sufficient evidence can be found to justify a full scale clinical trial. The two TR interventions are: " Peer Therapy Coach (PTC); this web-based peer intervention that focuses on supporting participation in outpatient psychotherapy will be developed in the proposed research " Motivational Interviewing (MI); this therapist-implemented intervention has been used to increase treatment adherence among adults and adolescents in addictions, health, and MH treatment, but has not specifically been tested as a TR strategy in transition age youth. Aim 1. Specify implementation and training protocols and a fidelity measure for a new outpatient MH psychotherapy TR intervention (PTC). Aim 2. Determine the feasibility of the PTC approach and randomized clinical trial research design comparing Motivational Interviewing and PTC to services as usual. This research will jump start progress towards retaining more transition age youth in widely used treatments by simultaneously developing a tailored TR intervention and testing a successful one not tried in this age group. It will be consistent with the President's Recovery and Reinvestment Act by putting 97% of its direct cost budget towards personnel, and providing jobs for youth with psychiatric disabilities. Youth with mental health needs during the transition to adulthood have tremendously compromised functioning in working, living independently, and staying out of trouble with the law. Office-based mental health treatment is accessed by 760,000 transition age youth (ages 17- 25) each year, but the impact of this widely available treatment is compromised in this age group because they are particularly prone to drop out of treatment. If the two promising treatment dropout prevention interventions pilot tested in the proposed research are successful, more transition age youth in the future will remain in treatment long enough for it to have its beneficial impact on symptoms and by extension, functioning.